| 1. |
- Af Winklerfelt Hammarberg, Sandra, et al.
(författare)
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Outcomes of psychiatric interviews and self-rated symptom scales in people on sick leave for common mental disorders: an observational study.
- 2022
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 12:6
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the correspondence between diagnoses on sick leave certificates and diagnoses made in structured psychiatric interviews. Secondary aims were to investigate length of sick leave by diagnoses on sick leave certificates, diagnoses made in structured interviews and symptom severity.Observational study consisting of a secondary analysis of data from a randomised controlled trial and an observational study.The regions of Stockholm and Västra Götaland, Sweden.480 people on sick leave for common mental disorders.Participants were examined with structured psychiatric interviews and self-rated symptom severity scales.(1) Sick leave certificate diagnoses, (2) diagnoses from the Mini International Neuropsychiatric Interview and the Self-rated Stress-Induced Exhaustion Disorder (SED) Instrument (s-ED), (3) symptom severity (Montgomery-Asberg Depression Rating Scale-self-rating version and the Karolinska Exhaustion Disorder Scale) and (4) number of sick leave days.There was little correspondence between diagnoses on sick leave certificates and diagnoses made in structured psychiatric interviews. Many participants on sick leave for SED, anxiety disorder or depression fulfilled criteria for other mental disorders. Most on sick leave for SED (76%) and anxiety disorder (67%) had depression (p=0.041). Length of sick leave did not differ by certificate diagnoses. Participants with SED (s-ED) had longer sick leave than participants without SED (144 vs 84 days; 1.72 (1.37-2.16); p<0.001). More severe symptoms were associated with longer sick leave.Diagnoses on sick leave certificates did not reflect the complex and overlapping nature of the diagnoses found in the structured psychiatric interviews. This finding is relevant to the interpretation of information from health data registers, including studies and guidelines based on these data. A result of clinical interest was that more severe symptoms predicted long-term sick leave better than actual diagnoses.
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| 2. |
- Finnes, Anna, et al.
(författare)
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Cost-Effectiveness of Acceptance and Commitment Therapy and a Workplace Intervention for Employees on Sickness Absence due to Mental Disorders.
- 2017
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Ingår i: Journal of Occupational and Environmental Medicine. - 1076-2752 .- 1536-5948. ; 59:12, s. 1211-1220
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to evaluate cost-effectiveness of Acceptance and Commitment Therapy (ACT) and workplace dialogue intervention (WDI), both as stand-alone interventions and in combination, compared with treatment as usual (TAU), for employees on sickness absence with mental disorders.METHODS: Employees (n = 352, 78.4% females) on sickness absence were randomized to one of four groups. Cost-utility analyses were conducted from a health care perspective and a limited societal perspective.RESULTS: All groups reported significant improvements in health-related quality-of-life (HRQoL) and there were no significant differences in HRQoL or costs between groups. The probability of cost-effectiveness for ACT+WDI was 50% compared with ACT, indicating that both treatment alternatives could be considered equally favorable for decision-makers. TAU and WDI were rejected due to less economic efficiency.CONCLUSION: Adding WDI to ACT cannot be recommended on the basis of our study results.
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| 3. |
- Finnes, Anna, et al.
(författare)
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Economic evaluation of return-to-work interventions for mental disorder-related sickness absence : two years follow-up of a randomized clinical trial
- 2022
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 48:4, s. 264-272
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective was to (i) assess the long-term cost-effectiveness of acceptance and commitment therapy (ACT), a workplace dialog intervention (WDI), and ACT+WDI compared to treatment as usual (TAU) for common mental disorders and (ii) investigate any differences in cost-effectiveness between diagnostic groups.METHODS: An economic evaluation from the healthcare and limited welfare perspectives was conducted alongside a randomized clinical trial with a two-year follow-up period. Persons with common mental disorders receiving sickness benefits were invited to the trial. We used registry data for cost analysis alongside participant data collected during the trial and the reduction in sickness absence days as treatment effect. A total of 264 participants with a diagnosis of depression, anxiety, or stress-induced exhaustion disorder participated in a two-year follow-up of a four-arm trial: ACT (N=74), WDI (N=60), ACT+WDI (N=70), and TAU (N=60).RESULTS: For all patients in general, there were no statistically significant differences between interventions in terms of costs or effect. The subgroup analyses suggested that from a healthcare perspective, ACT was a cost-effective option for depression or anxiety disorders and ACT+WDI for stress-induced exhaustion disorder. With a two-year time horizon, the probability of WDI to be cost-saving in terms of sickness benefits costs was 80% compared with TAU.CONCLUSIONS: ACT had a high probability of cost-effectiveness from a healthcare perspective for employees on sick leave due to depression or anxiety disorders. For participants with stress-induced exhaustion disorder, adding WDI to ACT seems to reduce healthcare costs, while WDI as a stand-alone intervention seems to reduce welfare costs.
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| 4. |
- Finnes, Anna, et al.
(författare)
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Psychological treatments for return to work in individuals on sickness absence due to common mental disorders or musculoskeletal disorders : a systematic review and meta-analysis of randomized-controlled trials
- 2019
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 92:3, s. 273-293
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Forskningsöversikt (refereegranskat)abstract
- Purpose: Common mental disorders (CMDs) and musculoskeletal disorders are highly prevalent in the population and cause significant distress and disability, and high costs to society. The main objective of this systematic review and meta-analysis was to examine the outcome and comparative effectiveness of psychological interventions in reducing sickness absence (SA) due to CMDs or musculoskeletal disorders, compared to a waitlist control group, usual care or another clinical intervention.Methods: We reviewed 3515 abstracts of randomized controlled trials published from 1998 to 2017. Of these, 30 studies were included in the analysis.Results: The psychological interventions were overall more effective than treatment as usual in reducing SA (small effect sizes), but not compared to other clinical interventions. Results were similar for studies on CMDs and musculoskeletal pain. A few significant moderating effects were found for treatment-specific variables. However, these were difficult to interpret as they pointed in different directions.Conclusion: There was a small but significant effect of psychological treatments in reducing SA. We identified areas of improvement such as methodological problems among the included studies and failure to specifically address RTW in the interventions that were evaluated. Clinical implications of the findings, and ways of improving methodological rigour of future studies are discussed.
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| 5. |
- Finnes, Anna, et al.
(författare)
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Randomized Controlled Trial of Acceptance and Commitment Therapy and a Workplace Intervention for Sickness Absence Due to Mental Disorders.
- 2019
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Ingår i: Journal of Occupational Health Psychology. - : Educational Publishing Foundation. - 1076-8998 .- 1939-1307. ; 24:1, s. 198-212
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Tidskriftsartikel (refereegranskat)abstract
- Mental disorders contribute to high rates of sickness absence (SA) and impaired work functioning. The aim of the present study was to evaluate the efficacy of 3 interventions targeting SA of workers. Participants (n = 352; 78.4% females) of working age with current employment, and SA due to depression, anxiety disorders, or exhaustion disorder, were recruited to the study and randomized to (a) acceptance and commitment therapy (ACT), (b) a workplace dialogue intervention (WDI), (c) a combination of ACT and WDI, or (d) treatment as usual (TAU). For SA days, there was a significant interaction effect for the follow-up period, in which ACT + WDI generated more SA compared with TAU. When diagnostic group was included as a moderator, participants with exhaustion disorder had less SA days in the WDI group compared with TAU. For symptoms of depression, anxiety, and stress-related ill health, there were significant interaction effects for ACT and ACT + WDI, when compared with TAU, from pre- to postmeasurement (small to moderate between-groups effect sizes). Within-group effect sizes pre- to postmeasurement (Cohen’s d) ranged from .55 to 1.17 (ACT), .40 to .94 (WDI), .26 to 1.13 (ACT + WI), and −.06 to .70 (TAU). There were no differences between groups during follow-up for symptoms.
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| 6. |
- Karlsson, Ida, et al.
(författare)
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Is a Problem-Solving Intervention with Workplace Involvement for Employees on Sickness Absence Due to Common Mental Disorders More Effective, than Care as Usual, in Reducing Sickness Absence Days? Results of a Cluster-Randomised Controlled Trial in Primary Health Care
- 2024
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Ingår i: JOURNAL OF OCCUPATIONAL REHABILITATION. - : Springer. - 1053-0487 .- 1573-3688.
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe aim was to evaluate the effectiveness of a problem-solving intervention with workplace involvement (PSI-WPI) added to care as usual (CAU) in reducing sickness absence days among employees with common mental disorders compared to CAU alone in Swedish primary health care on a monthly basis over 18-months follow-up.MethodsWe conducted a cluster-randomised controlled trial including 197 employees blinded to allocation (85 PSI-WPI and 112 CAU). As sickness absence data was skewed and over-dispersed, generalised estimating equations was used to enable a comparison between the intervention and control group for each month of the follow-up period.ResultsThe median number of sickness absence days over the 18-month follow-up was 78 days, inter-quartile range (IQR) 18-196 for employees receiving PSI-WPI and 64 days, IQR 18-161 for employees receiving CAU. The time x group generalised estimating equations analysis showed no statistically significant difference in sickness absence days per month.ConclusionThe addition of a PSI-WPI to CAU was not more effective in reducing sickness absence days. This may be explained by the primary health care context, lack of specialisation in occupational health and the Swedish social insurance system with specific time limits.Trial registration.The trial was registered at ClinicalTrials.gov, identifier: NCT03346395 on January 12th, 2018.ConclusionThe addition of a PSI-WPI to CAU was not more effective in reducing sickness absence days. This may be explained by the primary health care context, lack of specialisation in occupational health and the Swedish social insurance system with specific time limits.Trial registration.The trial was registered at ClinicalTrials.gov, identifier: NCT03346395 on January 12th, 2018.ConclusionThe addition of a PSI-WPI to CAU was not more effective in reducing sickness absence days. This may be explained by the primary health care context, lack of specialisation in occupational health and the Swedish social insurance system with specific time limits.Trial registration.The trial was registered at ClinicalTrials.gov, identifier: NCT03346395 on January 12th, 2018.
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| 7. |
- Rudman, Ann, et al.
(författare)
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Consequences of early career nurse burnout : A prospective long-term follow-up on cognitive functions, depressive symptoms, and insomnia.
- 2020
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Ingår i: eClinicalMedicine. - : Elsevier BV. - 2589-5370. ; 27
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Tidskriftsartikel (refereegranskat)abstract
- Background: Burnout is common among nurses and midwives. We examined whether an early career episode of burnout has long-term consequences on; a) cognitive functions, b) symptoms of depression, and/or c) insomnia for nurses a decade after graduation.Methods: Symptoms of burnout were investigated in an observational longitudinal study of three national cohorts of registered nurses (RNs). Nursing students were recruited from all 26 of Sweden's nursing programs. Burnout was subsequently measured through annual assessment over the first three years post graduation, with one long-term follow-up 11-15 years after graduation. A total of 2474 nurses (62%) consented to participate at follow-up. Burnout was measured using items from the Oldenburg Burnout Inventory, cognitive function by a study specific instrument, depressive symptoms by the Major Depression Inventory, and sleep problems using items from the Karolinska Sleep Questionnaire. We used logistic regression to identify factors associated with consequences of early career burnout, adjusting for concurrent levels at follow up.Findings: The prevalence of nurses reporting high levels of burnout symptoms at least one of the first three years of working life was 299 (12·3%). High levels of burnout symptoms in early working life were significantly related to more frequent symptoms of cognitive dysfunction, depression, and impaired sleep a decade later when taking current burnout levels into account. After controlling for both current symptoms of burnout and the other outcome variables, nurses with early career burnout still reported more frequent problems with cognitive functions and sleep but not depression.Interpretation: The results of this study show that the detrimental processes caused by overwhelming or chronic stress start early on in nurses' careers and thus preventive efforts should preferably be introduced early on (e.g. as part of nursing education and onboarding programs).Funding: AFA Insurance Grant [number 150284].
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| 8. |
- Finnes, Anna, et al.
(författare)
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Comparing the Efficacy of Multidisciplinary Assessment and Treatment, or Acceptance and Commitment Therapy, with Treatment as Usual on Health Outcomes in Women on Long-Term Sick Leave : A Randomised Controlled Trial
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain and mental disorders are common reasons for long term sick leave. The study objective was to evaluate the efficacy of a multidisciplinary assessment and treatment program including acceptance and commitment therapy (TEAM) and stand-alone acceptance and commitment therapy (ACT), compared with treatment as usual (Control) on health outcomes in women on long-term sick leave.Method: Participants (n = 308), women of working age on long term sick leave due to musculoskeletal pain and/or common mental disorders, were randomized to TEAM (n = 102), ACT (n = 102) or Control (n = 104). Participants in the multidisciplinary assessment treatment program received ACT, but also medical assessment, occupational therapy and social counselling. The second intervention included ACT only. Health outcomes were assessed over 12 months using adjusted linear mixed models. The results showed significant interaction effects for both ACT and TEAM compared with Control in anxiety (ACT [p < 0.05]; TEAM [p < 0.001]), depression (ACT [p < 0.001]; TEAM [p < 0.001]) and general well-being (ACT [p < 0.05]; TEAM [p < 0.001]). For self-rated pain, there was a significant interaction effect in favour of ACT (p < 0.05), and for satisfaction with life in favour of TEAM (p < 0.001).Conclusion: Both ACT alone and multidisciplinary assessment and treatment including ACT were superior to treatment as usual in clinical outcomes.
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| 9. |
- Finnes, Anna
(författare)
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Return to work : methods for promoting health and productivity in employees on sickness absence
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Sickness absence (SA) due to common mental disorders and musculoskeletal pain is highly prevalent worldwide and has increased markedly over the past decade. Mental and behavioral disorders account for more incapacity benefit claims than any other disorder. Evidence-based interventions such as cognitive behavioral therapy for depression and anxiety have proven to be effective treatments for these patient groups, however the effect on SA duration and return to work (RTW) is unclear. Overall, there is a lack of knowledge on how to treat patient in order to have satisfactory results for both symptoms and RTW. Purpose and aims: The purpose of this doctoral project was to evaluate the effect of psychological interventions on SA and RTW. The first aim was to identify published randomized controlled trials and evaluate the effect on SA in a systematic review and meta-analysis. The second aim was to investigate the effects and cost-effectiveness of Acceptance and Commitment Therapy (ACT) and the Workplace Dialogue Intervention (WDI) both separately and combined compared with treatment as usual (TAU). Methods: In study I, a systematic review and meta-analysis was conducted to evaluate the effect of psychological treatment on duration of SA and symptoms in patients on SA due to common mental disorders or musculoskeletal pain. In study II, patients (N = 352) were randomized to one of four groups, ACT, WDI, ACT+WDI, or TAU, and were followed up until one year after randomization regarding net SA days, work ability, level of function, satisfaction with life, and psychiatric symptoms. Study III was an economic evaluation of the same sample as in study II, consisting of a cost analysis and a cost-utility analysis from a health-care perspective and a limited societal perspective. In study IV, long-terms effects on outcome and economic evaluation were evaluated with a two-year time horizon. Results: In study I, 30 studies matched inclusion criteria and was included in the analysis. The metaanalysis yielded a significant but small effect size in favor of psychological treatments regarding duration of SA. There were no significant effects for symptoms of anxiety or depression. The results from study II showed no significant differences between groups over time for net SA days or work ability. Diagnostic group moderated the results. Patients with exhaustion disorder had more SA days in ACT+WDI compared with TAU and depressed patients had more SA days in WDI compared with TAU. For symptoms of depression, anxiety and exhaustion disorder, there were significant interaction effects in favor of ACT and ACT+WDI from pre- to post measurement when compared with TAU. The economic evaluation in study II showed that all groups reported significant improvements in healthrelated quality of life (HRQoL), but there were no significant differences between groups in HRQoL or costs. ACT was deemed cost-effective from a health-care perspective and the probability of cost-effectiveness for ACT+WDI compared with ACT was 50%. WDI and TAU were rejected due to less economic efficiency. In study IV, there were no differences between groups in terms of SA, work ability or symptoms of anxiety or depression. In the WDI group, participants with depression had more SA days compared to those with exhaustion disorder. The economic evaluation confirmed the results from the one-year follow-up. Conclusions and further directions: Evidence-based psychological treatments such as CBT is effective for treating symptoms of common mental disorders but the effect on SA duration and RTW is unsatisfactory. There is a great need for further development of return to work interventions and more well-designed intervention trials. Generally, study quality was low which introduces further doubt in the interpretation of the results. There were overall few differences between ACT, WDI, and ACT+WDI compared with TAU. Effects in terms of cost-effectiveness were also small, probably due to lack of treatment effects. There are many areas in need of further development and evaluation in sickness absence research. Interventions needs to be more specific in terms of theory, mechanisms of change and tailored to maximize effects for different subgroups.
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